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Lower Doses
Dec 25, 2004

Dr Young On 17 December you wrote: "Having a lower viral load might suggest that the likelihood of acheiving an undetectable viral load might actually be higher (or "easier")." This makes sense. It also seems reasonable that low viral loads could be made undetectable with lower doses of meds, but studies of meds seem to lump patients with various viral loads together when testing to find theright dose. What efforts have been made to test lower doses of HIV medications in patients who start with a lower viral load?

Response from Dr. Young

Thanks for your thoughtful post.

I'd agree that a worthy goal is trying to find the minimum amount of medications necessary to suppress viral loads-- indeed, this is a topic that continues to receive attention, as evidenced by some studies to look at lower dose d4T or the use of lower doses of ritonavir to boost other protease inhibitors.

The notion of using "less potent" drug cocktails for lower viral load situations is driven more by the statistical probabililty of generating a drug-resistant viral strain- the less virus present, the less likely that resistance will emerge at any given time.

Unfortunately, for your hypothesis, the drug concentration required to inhibit the virus is not determined by the amount of virus, but rather the chemical nature of the binding of the drug to the viral target. So, as long as the drug concentration is adequate to bind to the reverse transcriptase or protease, then the virus should be inhibited. Since the drug is usually in vast numerical excess to virus, the amount of virus in the blood does not determine the molar amount of drug needed.

Hope this helps, thanks for reading. BY



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